A Search For Limits

There are 1.5 million induced abortions every year. That's to be done with the remains? Bury them in a landfill or donate them to medical research, where organs and tissues may produce some good for others? The answer seems obvious. Or is it? Science does not advance in a moral vacuum. Time and again it intrudes on the concerns of conscience. Consider: in 1973 a team of Finnish and American scientists decapitated a dozen human fetuses, each aborted live through hysterotomy, and kept the heads alive artificially for study. The ghoulish experiment -partially funded by the National Institutes of Health-was designed to measure fetal metabolism. At about the same time, another research team kept a batch of aborted fetuses alive in saline solution in order to find out if they could absorb oxygen. One fetus survived for nearly a day.

When word of these experiments reached the public, the out cry was such that NIH halted all federally funded fetal research except that which directly benefited the fetus. Those rules still hold. But now that the NIH is free to fund research using aborted human tissue for transplantation, the public-no less than politicians, physicians and science researchers--still faces profound moral questions. What limits any, should be observed when experimenting with human fetuses? Does a mother who aborts her fetus have the moral right to then donate that fetus to science-or have any say at all about the disposition of the body.? Will the opportunity to donate their fetuses to research that might help others influence more women to elect abortion?

Now factor in the profit motive. Why not allow fetuses to be sold, like blood, or imported from poorer countries? Should society allow the stockpiling of spare fetal parts for nonmedical purposes, such as replacement therapy for sagging cheeks and aging stomach muscles? Will fetal research lead to a bioengineering industry that, in turn, will require more and more fetuses as raw material for pharmaceutical and other products? Could there--should there-be a futures market in precious fetal orphans? Who will police ethics guidelines--and who will punish violators? No one denies the pertinence of such questions. Difficult in their own right, they also illuminate the confounding ambiguity that still haunts the issue of abortion. It's been 20 years since the U.S. Supreme Court's decision in Roe v. Wade. In legalizing abortion, the court ruled that the fetus has no constitutional right to protection by the law. Legally, the fetus is now a nothing. And yet, as public-policy analyst Andrew Kimbrell argues in his forthcoming book, "The Human Body Shop" (357 pages. Harpers. $20), the fetus is clearly a growing human organism; a human nothing. That is why it is so highly prized as a source for tissue and organ transplantation. And that is also why, Kimbrell believes, the morality of using fetal materials is too important to leave to scientists alone.

Many ethicists who specialize in biomedical issues believe that fetal research and transplantation can, and should, be regulated. Indeed, much of the legislation now moving through Congress is based on the recommendations issued by an NIH ethics advisory panel in 1988. In essence, the panel suggested a series of procedural guidelines aimed at erecting a wall of separation between the scientific use of fetal remains and the means-induced abortion-by which they are obtained. In its report, which passed 174, the panel insisted that abortion counselors should not even discuss the donation of fetuses to science until after clients have decided to undergo an abortion. In other words, pregnant women should not allow the possible scientific benefit to others to influence their decision whether to abort or carry their child. Similarly, physicians should not alter the means or methods of abortion in order to produce better specimens for subsequent experiment. In short, women should not be morally or physically coerced into providing fetal tissue for scientific or therapeutic purposes. Both decisions-to abort and to donate-should be hers alone and made independently of each other.

In addition, once a woman chooses to abort her fetus, the panel urged that she not be permitted to designate the beneficiary of the aborted tissue. This regulation would thus prevent women from conceiving and aborting in order to provide fetal tissue for transplantation for an ailing relative or friend. Further, in keeping with laws in some states, the proposed guidelines would disallow the sale of fetal tissue or organs for transplantation, in an effort to prevent both physicians and women, here or abroad, from seeking abortions for profit. But they would permit payment of reasonable fees to companies and other third parties for the retrieval, preparation and storage of fetal materials. Finally, the panel declared that at all stages everyone involved in fetal research and transplantation should "accord human fetal tissue the same respect accorded other cadaveric human tissues entitled to respect." That's a curious rule that only a committee could love. Cadavers were once human beings and hence worthy of respect. But fetuses, what were they? In life, nothing. In death, deserving a modicum of care.

Even though the panel achieved an ethical majority, the testimony they heard made clear that Americans are far from agreement on the morality of fetal-tissue transplantation. In general, representatives of the diabetes and other advocacy associations judged the ethics of using fetal tissue solely by the hoped-for end of finding cures. They make a powerful case: extract some good from tragedy by easing those who are suffering. The medical researchers themselves, while welcoming procedural guidelines, bristled at the notion that their intentions could be regarded as anything other than altruistic. Just as predictably life spokespersons maintained that intentionally aborted fetuses should not be "harvested" for medical research.

The majority of the panelists concluded that, regardless of how one judges the morality of abortion, researchers in fetal transplantation "could be ethically isolated" from physicians who do abortions. But in a vigorous minority report, moral theologian James T. Burtchaell of Notre Dame University and James Bopp Jr., an attorney for the National Right to Life Committee, challenged this conclusion. On the contrary, they argued, both procedures are so intertwined-materially, financially and technologically-that "a symbiotic relationship between the abortion industry and fetal-tissue transplantation therapy" cannot be avoided. Further, they wrote, everyone involved in an elective abortion--especially the mother-is morally disqualified from deciding how the fetal remains should be disposed, "as the man who has killed his wife is morally disqualified from acting as her executor." In this respect, they insisted, the donation of aborted fetal tissue is ethically different from the choice facing the guardian of an accident victim whose organs are suitable for transplant.

There are some pro-choice feminists, too, who nonetheless worry about the implications of fetal research. In the worst-case scenarios, they see the specter of dehumanized women, whose bodies have become fetal factories. "The role of women in fetal-tissue research is, after all, to provide the raw material," says Janice Raymond, a professor of Women's Studies and Medical Ethics at the University of Massachusetts. "One primary effect of fetal-tissue research and transplants," Raymond writes in On the Issues, a liberal women's quarterly, "has been to turn women into fetal-tissue containers; mere material environments for the fetus."

Even with the adoption of the panel's guidelines, Raymond and other critics doubt that they can be enforced or properly policed. Though long on ethical procedures, the panel had no advice on corresponding penalties. Just as physicians could and did do abortions when they were illegal, so could they privately arrange to have fetal tissue supplied to relatives of the donor. Laws proposed by Congress, however, criminalize the sale of fetal tissue across state lines; state laws will have to do the rest. But the NIH itself has no power to police free-standing abortion clinics in order to ensure that counselors do not advocate abortions for the sake of science, or use abortion methods that are medically riskier for women in order to obtain better fetal specimens.

Yet without some sort of ethical standards, fetal-tissue transplantation threatens to become an unsupervised private industry. In many ways it already is. Kimbrell charges that at least a half dozen companies supply fetal tissues to clients and estimates annual sales of several million dollars. "A fetal-tissue transplant industry," warns economist Emanuel Throne, coauthor of a report for Congress's Office of Technology Assessment, "could dwarf the present organ-transplant industry."

Worse, argues Kimbrell, there currently are few legal barriers to prevent private firms and hospitals from using fetal transplantation for cosmetic and other nonmedical purposes. For example, he cites researchers in Canada who have found that injections from fetal tissue accelerate the healing of muscles in animals. What works for animals could help humans as well. The next step, he suggests, could be the use of fetal injections to enhance-like steroids--the ability of athletes, thus raising the specter of Olympic competitors running on "baby power."

Although such scenarios may seem farfetched, even ethicists who support fetal-tissue research warn that the research and medical communities need to take action to keep emerging biotechnologies in check. Unlike drugs or medical devices, which are regulated by the Food and Drug Administration, fetal-tissue transplantation is a surgical procedure that can be regulated only by each hospital's research ethics committees. "These committees have institutional loyalties and a heavy medical membership," observes Arthur Caplan of the Center for Biomedical Ethics at the University of Minnesota, "and may not always be able to give independent assessments." Bioethicist LeRoy Walters of Georgetown University thinks the only practical solution is for the federal government to fund a fetal-tissue bank to keep "research and transplantation carefully insulated against commercialization."

Clearly, society should foster research to alleviate human suffering. Just as clearly, it must also protect itself against the callous use of human material, even in its early stages of development. Even though human fetuses have been thrust into a legal limbo, they still elicit feelings of protection and respect. The question society still has not resolved is: how much?